US20160324536A1 - Medical treatment instrument - Google Patents
Medical treatment instrument Download PDFInfo
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- US20160324536A1 US20160324536A1 US15/215,035 US201615215035A US2016324536A1 US 20160324536 A1 US20160324536 A1 US 20160324536A1 US 201615215035 A US201615215035 A US 201615215035A US 2016324536 A1 US2016324536 A1 US 2016324536A1
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- United States
- Prior art keywords
- needle
- diameter
- distal end
- small
- diameter portion
- Prior art date
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/02—Instruments for taking cell samples or for biopsy
- A61B10/06—Biopsy forceps, e.g. with cup-shaped jaws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/02—Instruments for taking cell samples or for biopsy
- A61B10/04—Endoscopic instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
- A61B2017/2937—Transmission of forces to jaw members camming or guiding means with flexible part
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320064—Surgical cutting instruments with tissue or sample retaining means
Definitions
- the present invention relates to a medical treatment instrument, and more particularly, to a medical treatment instrument which is inserted into a body cavity through a treatment instrument channel of an endoscope to collect tissue or a cell at a predetermined portion of the body cavity.
- a treatment instrument which performs treatment of tissue or a cell at a predetermined portion of a body cavity for example, a treatment instrument described in Japanese Unexamined Patent Application, First Publication No. 2008-5965 is known.
- a treatment instrument which performs treatment of a submucosal tumor is disclosed. The treatment instrument described in Japanese Unexamined Patent Application, First Publication No.
- 2000-201939 includes a sheath, an operation motion transmission member which is disposed to be capable of advancing and retracting in its axial direction along the sheath to advance and retract by an operation from a hand side, and a pair of distal end treatment members disposed to be openable and closable in the shape of a beak at a distal end of the sheath to be opened and closed by the advancing and retracting movement of the operation motion transmission member.
- distal end portions of the pair of distal end treatment members are formed in acute shapes to be sharp at the front.
- aspiration biopsy which is performed by Fine-Needle Aspiration (FNA), for example, is known.
- FNA Fine-Needle Aspiration
- tissue is punctured with a biopsy needle, and then the tissue is aspirated by filling a negative pressure in the biopsy needle with a syringe, and so on.
- a medical treatment instrument includes: a tubular sheath; a needle formed in a tubular shape and inserted into the sheath such that the needle is capable of advancing and retracting; a stylet having a first outer diameter and inserted into the needle such that the stylet is capable of advancing and retracting; a housing portion which is elastically deformable at a distal end portion of the needle, the housing portion having a space formed in a tubular inside of the distal end portion of the needle; a small-diameter portion provided at a proximal end of the housing portion and having an inner diameter smaller than an inner diameter of the housing portion; a slit extending at least from a distal end of the housing portion to the small-diameter portion, the slit being configured to cause an outside of the needle to communicate with the space; and a large-diameter portion having a second outer diameter which is larger than the first outer diameter at a distal end portion of the stylet, the
- the first outer diameter may be smaller than the inner diameter of the small-diameter portion.
- the second outer diameter may be larger than the inner diameter of the small-diameter portion and is smaller than the inner diameter of the housing portion.
- the slit may include a plurality of slits which are formed at the housing portion.
- the large-diameter portion may be positioned closer to a distal end side than the small-diameter portion in an initial state, and the large-diameter portion may expand the small-diameter portion by the stylet being pulled toward a proximal end side with respect to the needle.
- the housing portion when the large-diameter portion is disengaged from the small-diameter portion by the stylet being pulled toward proximal end side from a position at which the large-diameter portion is engaged with the small-diameter portion, the housing portion may be closed.
- FIG. 1 is a view showing an endoscope used together with a medical treatment instrument according to a first embodiment of the present invention.
- FIG. 2 is a lateral view of the medical treatment instrument.
- FIG. 3 is a lateral cross-sectional view of the medical treatment instrument.
- FIG. 4 is a view showing the medical treatment instrument viewed from an arrow A in FIG. 2 .
- FIG. 5 is a lateral cross-sectional view of a distal end portion of the medical treatment instrument.
- FIG. 6 is a lateral cross-sectional view when the distal end portion of the medical treatment instrument expands.
- FIG. 7 is a view showing an operation when the medical treatment instrument is being used.
- FIG. 8 is a view showing an operation when the medical treatment instrument is being used.
- FIG. 9 is a view showing an operation when the medical treatment instrument is being used.
- FIG. 10 is a view showing an operation when the medical treatment instrument is being used.
- FIG. 11 is a lateral cross-sectional view of a distal end portion of a medical treatment instrument according to a second embodiment of the present invention.
- FIG. 12 is a view showing a state in which a distal end portion of a needle of the medical treatment instrument is closed.
- FIG. 13 is a view showing a state in which the distal end portion of the needle of the medical treatment instrument is open.
- FIG. 14 is a view showing the needle viewed from an arrow B in FIG. 12 .
- FIG. 15 is a view showing an operation when the medical treatment instrument is being used.
- FIG. 16 is a view showing an operation when the medical treatment instrument is being used.
- FIG. 17 is a view showing an operation when the medical treatment instrument is being used.
- FIG. 1 is a view showing an endoscope 100 used together with a medical treatment instrument 1 according to the embodiment.
- the endoscope 100 includes an endoscope insertion part 101 inserted into a body, and an operation part 102 which operates the endoscope insertion part 101 .
- the operation part 102 is provided at a proximal end of the endoscope insertion part 101 .
- the operation part 102 bends a distal end portion of the endoscope insertion part 101 by an angular wire (not shown).
- a known imaging means which observes an inside of the body is provided at a distal end of the endoscope insertion part 101 .
- a channel 103 is formed inside the endoscope insertion part 101 .
- the channel 103 extends from the distal end of the endoscope insertion part 101 to a portion near a side part of the operation part 102 .
- An opening of a distal end of the channel 103 is formed at the distal end of the endoscope insertion part 101 , and an opening of a proximal end of the channel 103 is formed at the portion near the side part of the operation part 102 .
- the opening of the proximal end of the channel 103 is an insertion port of a treatment instrument which is inserted into the endoscope 100 .
- the medical treatment instrument 1 according to the embodiment is inserted into the channel 103 through the insertion port.
- FIG. 2 is a lateral view of the medical treatment instrument 1 according to the embodiment.
- FIG. 3 is a lateral cross-sectional view of the medical treatment instrument 1 .
- FIG. 4 is a view showing the medical treatment instrument 1 viewed from an arrow A in FIG. 2 .
- FIG. 5 is a lateral cross-sectional view of a distal end portion of the medical treatment instrument 1 .
- the medical treatment instrument 1 includes a needle 10 , a stylet 30 , and a sheath 40 .
- the needle 10 is formed in a tubular shape and is inserted into the sheath 40 to be capable of advancing and retracting.
- the stylet 30 has a predetermined outer diameter (first outer diameter) and is inserted into the needle 10 to be capable of advancing and retracting.
- the needle 10 is constituted with a metal such as stainless steel or a nickel-titanium alloy and can be elastically deformed.
- the needle 10 is formed in the tubular shape and has a lumen 11 .
- the needle 10 may be, for example, a 19-gauge needle (outer diameter of 1.1 mm, inner diameter of 0.78 mm).
- a needle which is narrower than the needle having the size above may also be used as the needle 10 .
- a distal end of the needle 10 is formed in the shape of a curved surface so as to easily puncture tissue with the needle 10 .
- the distal end of the needle 10 may also be formed in an acute shape.
- a distal end portion 12 of the needle 10 can be elastically deformed. As shown in FIG. 5 , the distal end portion 12 of the needle 10 has a housing portion 14 , a small-diameter portion 16 , and a slit 18 . A space 15 is formed in the housing portion 14 .
- the small-diameter portion 16 is provided at a proximal end of the housing portion 14 , and has a smaller inner diameter than an inner diameter of the housing portion 14 .
- the slit 18 extends at least from a distal end of the housing portion 14 to a proximal end of the small-diameter portion 16 , and communicates with the space 15 .
- the space 15 capable of accommodating tissue to be collected is formed in the housing portion 14 .
- the inner diameter and the outer diameter of the housing portion 14 are substantially the same as the inner diameter and the outer diameter of the needle 10 which is closer to the proximal end side than the distal end portion 12 , respectively.
- the inner diameter and the outer diameter of the housing portion 14 may respectively be set differently from the inner diameter and the outer diameter of the needle 10 which is closer to the proximal end side than the distal end portion 12 .
- the length of the housing portion 14 in an axial direction of the needle 10 is properly set depending on an amount of tissue to be collected.
- the size of the space 15 is defined by the inner diameter of the housing portion 14 and the length of the housing portion 14 in the axial direction of the needle 10 .
- the small-diameter portion 16 is provided at the proximal end of the housing portion 14 .
- the small-diameter portion 16 has a smaller inner diameter than other portions of the needle 10 including the housing portion 14 .
- the small-diameter portion 16 may be formed by making a part of a proximal end side of the housing portion 14 in the needle 10 concave in a radial direction of the needle 10 . In this case, the small-diameter portion 16 has a smaller outer diameter than other portions of the needle 10 including the housing portion 14 .
- a proximal end of the small-diameter portion 16 continues to a straight tube portion of the needle 10 .
- the straight tube portion of the needle 10 is formed in the shape of a tube with a fixed inner diameter and a fixed outer diameter.
- the slit 18 is formed at the distal end portion 12 , and extends from the distal end of the needle 10 (distal end of the housing portion 14 ) to the proximal end of the distal end portion 12 .
- the slit 18 should extend at least from the distal end of the needle 10 to the proximal end of the small-diameter portion 16 .
- an example in which three slits 18 are formed is shown.
- the number of slits is not limited as long as there are one or more slits.
- the slits 18 are preferably formed at equal intervals in a circumferential direction of the needle 10 .
- the slits 18 communicate with the lumen 11 and the space 15 .
- the slits 18 intersect with or join each other at the distal end of the needle 10 .
- the distal end portion 12 is divided into three portions by the slits 18 .
- the widths of the slits 18 in the circumferential direction of the needle 10 are not particularly limited as long as the distal end portion 12 is divided by the slits 18 .
- the widths of the slits 18 are preferably as narrow as possible.
- the slits 18 are formed in linear shapes along a longitudinal axis of the needle 10 , the shapes of the slits 18 are not limited thereto.
- the slits 18 may be formed in linear shapes inclined with respect to the longitudinal axis of the needle 10 or curved shapes.
- a needle operation part 20 is provided at the proximal end of the needle 10 .
- an insertion passage 21 which communicates with the lumen 11 is formed.
- the stylet 30 has the predetermined outer diameter (first outer diameter), and is inserted into the needle 10 to be capable of advancing and retracting.
- the stylet 30 is constituted with metal such as stainless steel, and is formed in the shape of a round rod.
- the stylet 30 is inserted into the lumen 11 and the insertion passage 21 , and is capable of advancing and retracting with respect to the needle 10 .
- the outer diameter (first outer diameter) of the stylet 30 is smaller than the inner diameter of the small-diameter portion 16 .
- a distal end portion 32 of the stylet 30 has a large-diameter portion 34 .
- the large-diameter portion 34 is formed in a substantially cylindrical shape, and has an outer diameter (second outer diameter) larger than the outer diameter (first outer diameter) of other portions of the stylet 30 .
- the outer diameter (second outer diameter) of the large-diameter portion 34 is larger than the inner diameter of the small-diameter portion 16 , and is smaller than the inner diameter of the housing portion 14 .
- a stylet operation part 36 is provided at a proximal end of the stylet 30 .
- the stylet 30 can advance and retract with respect to the needle 10 .
- the sheath 40 is constituted with a resin material, and is formed in a tubular shape.
- the sheath 40 may be formed by a coil sheath around which a wire of a metal material such as stainless steel is tightly wound with no gaps formed therebetween.
- the needle 10 is inserted into a lumen of the sheath 40 to be capable of advancing and retracting with respect to the sheath 40 .
- the medical treatment instrument 1 is inserted into the channel 103 , the distal end of the needle 10 is stored in the sheath 40 . In this way, damage of the needle 10 or the channel 103 due to direct contact between the needle 10 and an inner surface of the channel 103 is prevented.
- a sheath operation part 42 is provided at a proximal end of the sheath 40 .
- the sheath 40 can advance and retract with respect to the channel 103 of the endoscope 100 .
- FIG. 6 is a lateral cross-sectional view when the distal end portion of the medical treatment instrument 1 expands.
- the large-diameter portion 34 can be engaged with the small-diameter portion 16 .
- the inner diameter of the small-diameter portion 16 is smaller than the outer diameter of the large-diameter portion 34 .
- the needle 10 can be elastically deformed, by the width of the slit 18 being expanded in the circumferential direction of the needle 10 , the inner diameter of the small-diameter portion 16 can be expanded up to the size which is approximately the same as the outer diameter of the large-diameter portion 34 . For this reason, the large-diameter portion 34 can be engaged with the small-diameter portion 16 .
- the large-diameter portion 34 is positioned closer to the distal end side than the small-diameter portion 16 in an initial state. From this state, by retracting the stylet operation part 36 to pull the stylet 30 toward the proximal end side with respect to the needle 10 , as shown in FIG. 6 , the large-diameter portion 34 moves toward the proximal end side and is engaged with the small-diameter portion 16 so that the width of each of the slits 18 expands. When the large-diameter portion 34 is engaged with the small-diameter portion 16 , an operator who operates the stylet operation part 36 feels an operation sensation (clicking sensation).
- each of the three portions of the distal end portion 12 is elastically deformed to move toward the outside in the radial direction of the needle 10 . That is, the housing portion 14 and the small-diameter portion 16 expand in the radial direction of the needle 10 so that the space 15 is open to the outside of the needle 10 .
- each of the three portions of the distal end portion 12 is elastically deformed to move to the inside in the radial direction of the needle 10 by an elastic force attempting to restore to the original shape of the needle 10 , and the width of each of the slits 18 is restored to the original size.
- the housing portion 14 and the small-diameter portion 16 are closed, and the space 15 is closed with respect to the outside of the needle 10 .
- the distal end portion 12 performs the same operation when the large-diameter portion 34 is moved from the proximal end side toward the distal end side of the small-diameter portion 16 .
- FIGS. 7 to 10 are views showing an operation when the medical treatment instrument 1 is being used.
- the above treatment of collecting tissue of a gastric submucosal tumor will be described as an example.
- a mucosa M, muscularis mucosae MM, a submucosa SM, a proper muscle PM, and a subserosa SS are disposed in that order, and a submucosal tumor ST is formed in the proper muscle PM.
- an operator inserts the endoscope insertion part 101 of the endoscope 100 from a patient's mouth into the body cavity, and moves the distal end of the endoscope insertion part 101 up to a portion near a target portion T.
- the medical treatment instrument 1 is inserted into the channel 103 , and the distal end of the medical treatment instrument 1 is moved up to the distal end of the endoscope insertion part 101 .
- the distal end of the needle 10 is stored in the sheath 40 .
- the large-diameter portion 34 of the stylet 30 is arranged at the distal end side of the small-diameter portion 16 of the needle 10 in the initial state will be described.
- the operator operates the sheath operation part 42 to cause the sheath 40 to protrude from the distal end of the endoscope insertion part 101 while observing the target portion T with an imaging means provided at the distal end of the endoscope insertion part 101 . Then, the operator advances the needle operation part 20 to cause the needle 10 to protrude from the distal end of the sheath 40 , and punctures the target portion T by the needle 10 .
- the operator When the target portion T is punctured by the needle 10 , as shown in FIG. 7 , the operator first inserts the distal end of the needle 10 into the submucosa SM. Next, as shown in FIG. 8 , the operator retracts the stylet operation part 36 and pulls the stylet 30 toward the proximal end side with respect to the needle 10 to move the large-diameter portion 34 toward the proximal end side. Thus, the large-diameter portion 34 is engaged with the small-diameter portion 16 , and the housing portion 14 expands.
- the housing portion 14 since the housing portion 14 is inside the mucosa M, the operator is unable to see that the housing portion 14 has expanded with the imaging means of the endoscope insertion part 101 . However, the operator can determine that the housing portion 14 has expanded by feeling the clicking sensation generated due to the engagement between the large-diameter portion 34 and the small-diameter portion 16 .
- the operator operates the needle operation part 20 and sticks the needle 10 into the submucosal tumor ST as shown in FIG. 9 .
- the operator retracts the stylet operation part 36 and pulls the stylet 30 further toward the proximal end side with respect to the needle 10 to move the large-diameter portion 34 further toward the proximal end side.
- the housing portion 14 is closed by the elastic force of the needle 10 .
- tissue of the submucosal tumor ST can be collected into the space 15 .
- the housing portion 14 is inflated slightly more than in the originally closed state. That is, the housing portion 14 can collect tissue of a larger volume than a volume defined by the inner diameter of the housing portion in a state in which the housing portion 14 is closed. While the housing portion 14 is closed, the operator retracts the needle operation part 20 to retract the needle 10 until the distal end of the needle 10 is stored in the sheath 40 . The operator withdraws the medical treatment instrument 1 from the channel 103 .
- the large-diameter portion 34 is arranged at the distal end side of the small-diameter portion 16 in the initial state
- the large-diameter portion 34 may be arranged at the proximal end side of the small-diameter portion 16 in the initial state. In this case, the operation of moving the large-diameter portion 34 toward the proximal end side in the description above is substituted with an operation of moving the large-diameter portion 34 toward the distal end side.
- the slits 18 are provided at the distal end portion 12 of the needle 10 , and the distal end portion 12 (the housing portion 14 and the small-diameter portion 16 ) can be elastically deformed to expand toward the outside in the radial direction. In this way, a sufficient amount of tissue can be collected even when the outer diameter of the needle 10 is narrow.
- the distal end portion 12 is restored to the originally closed state by its elastic force. For this reason, even when collecting tissue of the submucosal tumor which is hard tissue, the distal end portion 12 can be restored to the originally closed state by its elastic force overcoming the hardness of the tissue, and the tissue can be reliably collected.
- a blade may be formed at a portion where the slit 18 of the distal end portion 12 of the needle 10 is formed. In this way, when the distal end portion 12 is closed, the tissue can be easily split and collected.
- the operator can recognize that the large-diameter portion 34 is engaged with the small-diameter portion 16 by the clicking sensation.
- the medical treatment instrument 1 may be constituted in a way that the operator can check that the large-diameter portion 34 is engaged with the small-diameter portion 16 .
- the sheath 40 is not an essential constitution.
- the medical treatment instrument 1 may not include the sheath 40 .
- a known sheath and the medical treatment instrument 1 may be used in combination.
- a medical treatment instrument 201 according to the embodiment is different from the medical treatment instrument 1 according to the first embodiment in that the stylet 30 is not included. Further, in the medical treatment instrument 201 according to the embodiment, constitutions of the distal end portion of the needle 10 and the distal end portion of the sheath 40 are different from those of the medical treatment instrument 1 according to the first embodiment. In addition, with respect to parts having the same constitutions as the medical treatment instrument 1 according to the first embodiment, a detailed description thereof will be omitted.
- FIG. 11 is a lateral cross-sectional view of a distal end portion of the medical treatment instrument 201 according to the embodiment.
- FIG. 12 is a view showing a state in which a distal end portion 212 of a needle 210 of the medical treatment instrument 201 is closed.
- FIG. 13 is a view showing a state in which the distal end portion 212 of the needle 210 of the medical treatment instrument 201 is open.
- FIG. 14 is a view showing the needle 210 viewed from an arrow B in FIG. 12 .
- the medical treatment instrument 201 includes the needle 210 and a sheath 240 , but does not include a stylet.
- the distal end portion 212 of the needle 210 includes a housing portion 214 , a straight tube portion 222 provided at a proximal end of the housing portion 214 , and a stepped portion 224 provided at a proximal end of the straight tube portion 222 .
- a space 215 capable of accommodating tissue to be collected is formed in the housing portion 214 .
- a slit 218 which extends from the distal end to the proximal end of the housing portion 214 is formed in the housing portion 214 .
- the number of slits is not limited thereto as long as there are one or more slits.
- the slits 218 are preferably formed at equal intervals in a circumferential direction of the needle 210 .
- Each of the slits 218 communicates with the space 215 .
- the slits 218 intersect with or join each other at the distal end of the needle 210 .
- the housing portion 214 is divided into three portions by the slits 218 . As shown in FIG.
- each of the three portions of the housing portion 214 is formed in a shape that expands toward the outside in the radial direction of the needle 210 by plastic deformation.
- the housing portion 214 can be elastically deformed in the closed state by a sheath distal end member 242 to be described below.
- FIG. 12 while the housing portion 214 is closed, the distal end of the housing portion 14 is formed in the shape of a curved surface.
- tissue can be easily punctured by the needle 210 .
- An outer diameter of the housing portion 214 when the housing portion 214 is closed is properly set in consideration of the puncturing performance.
- the straight tube portion 222 is disposed between the housing portion 214 and the stepped portion 224 .
- the straight tube portion 222 has an inner diameter and an outer diameter which are respectively substantially the same as the inner diameter and the outer diameter of the housing portion 214 when the housing portion 214 is closed.
- the outer diameter of the straight tube portion 222 is smaller than an outer diameter of portions of the needle 210 other than the housing portion 214 .
- the length of the straight tube portion 222 in the axial direction of the needle 210 is properly set depending on a length to which target tissue is punctured by the needle 210 .
- the stepped portion 224 has a shape which extends from the straight tube portion 222 while an outer diameter thereof expanding.
- the stepped portion 224 comes in contact with a protruding portion 244 of the sheath distal end member 242 to be described below.
- the needle 210 is prevented from moving further toward the distal end side with respect to the sheath 240 .
- the sheath distal end member 242 is mounted at a distal end of the sheath 240 .
- the sheath distal end member 242 is formed in a tubular shape having an inner diameter and an outer diameter which are respectively substantially the same as the inner diameter and the outer diameter of the sheath 240 .
- a lumen of the sheath distal end member 242 communicates with a lumen of the sheath 240 , and the needle 210 is inserted into the lumen of the sheath distal end member 242 .
- the needle 210 can advance and retract with respect to the sheath 240 and the sheath distal end member 242 .
- the protruding portion 244 which protrudes toward the inside in the radial direction of the sheath distal end member 242 is provided at the distal end of the sheath distal end member 242 .
- an opening 246 which communicates with the lumen of the sheath distal end member 242 is formed further toward the inside in the radial direction than the protruding portion 244 .
- the diameter of the opening 246 is slightly larger than the outer diameter of the straight tube portion 222 , and is smaller than the outer diameter of the stepped portion 224 .
- the housing portion 214 can be inserted into the opening 246 . That is, by the housing portion 214 being inserted into the opening 246 , an outer surface of the housing portion 214 is pressed by the protruding portion 244 , and the housing portion 214 is elastically deformed in the closed state.
- FIGS. 15 to 17 are views for describing an operation when the medical treatment instrument 201 is being used.
- the treatment of collecting tissue of a gastric submucosal tumor will be described as an example.
- the operator uses the endoscope 100 to send the distal end of the medical treatment instrument 201 to a portion near the target portion T.
- the operator advances the needle operation part 20 to cause the needle 210 to protrude from the distal end of the sheath distal end member 242 .
- a part of the housing portion 214 is arranged in the opening 246 , and the housing portion 214 is closed by the protruding portion 244 . In this state, the operator punctures the target portion T with the needle 210 .
- the operator advances the needle 210 with respect to the sheath distal end member 242 .
- the housing portion 214 passes the protruding portion 244 and moves toward the distal end side, as shown in FIG. 16 , the housing portion 214 is restored to the originally expanded state while pushing circumferential tissue by an elastic force attempting to restore to the original shape of the housing portion 214 .
- the operator further advances the needle 210 with respect to the sheath distal end member 242 until the stepped portion 224 comes in contact with the protruding portion 244 . In this way, tissue of the submucosal tumor ST is accommodated in the space 215 of the housing portion 214 .
- the outer surface of the housing portion 214 is pressed by the protruding portion 244 , and thus the housing portion 214 is closed by elastic deformation. In this way, the tissue accommodated in the space 215 can be collected. Then, the needle 210 is withdrawn from the target portion T, and the medical treatment instrument 201 is withdrawn from the body.
- the slits 218 are provided at the housing portion 214 of the needle 210 , the housing portion 214 is formed by plastic deformation in the shape that expands toward the outside in the radial direction, and the housing portion 214 can be closed by elastic deformation. Accordingly, after tissue is punctured by the needle 210 while the housing portion 214 is closed, the housing portion 214 is expanded, and thus a sufficient amount of tissue can be collected even when the outer diameter of the needle 210 is narrow.
- the housing portion 214 is closed due to the outer surface of the housing portion 214 being pressed by the protruding portion 244 of the sheath distal end member 242 . Accordingly, even when collecting tissue of a submucosal tumor which is hard tissue, the housing portion 214 can be closed with a force overcoming the hardness of the tissue, and the tissue can be reliably collected.
Abstract
A medical treatment instrument includes a sheath, a needle advanceably and retractably inserted into the sheath, and a stylet having a first outer diameter and advanceably and retractably inserted into the needle. A distal end portion of the needle includes a housing portion, a small-diameter portion provided at a proximal end of the housing portion and having an inner diameter smaller than that of the housing portion, and a slit extending at least from a distal end of the housing portion to a proximal end of the small-diameter portion. A distal end portion of the stylet includes a large-diameter portion having a second outer diameter larger than the first outer diameter. The small-diameter portion and the housing portion are elastically deformed to expand in a radial direction of the needle while a width of the slit expands by the large-diameter portion being engaged with the small-diameter portion.
Description
- This application is a continuation application based on PCT Patent Application No. PCT/JP2015/063098, filed May 1, 2015, whose priority is claimed on Japanese Patent Application No. 2014-166318, filed Aug. 19, 2014. The contents of both the PCT Patent Application and the Japanese Patent Application are incorporated herein by reference.
- 1. Field of the Invention
- The present invention relates to a medical treatment instrument, and more particularly, to a medical treatment instrument which is inserted into a body cavity through a treatment instrument channel of an endoscope to collect tissue or a cell at a predetermined portion of the body cavity.
- 2. Description of Related Art
- Conventionally, as a treatment instrument which performs treatment of tissue or a cell at a predetermined portion of a body cavity, for example, a treatment instrument described in Japanese Unexamined Patent Application, First Publication No. 2008-5965 is known. In addition, in Japanese Unexamined Patent Application, First Publication No. 2000-201939, a treatment instrument which performs treatment of a submucosal tumor is disclosed. The treatment instrument described in Japanese Unexamined Patent Application, First Publication No. 2000-201939 includes a sheath, an operation motion transmission member which is disposed to be capable of advancing and retracting in its axial direction along the sheath to advance and retract by an operation from a hand side, and a pair of distal end treatment members disposed to be openable and closable in the shape of a beak at a distal end of the sheath to be opened and closed by the advancing and retracting movement of the operation motion transmission member. In the treatment instrument, distal end portions of the pair of distal end treatment members are formed in acute shapes to be sharp at the front. By the treatment instrument, puncture of a submucosal tumor and collection of a biopsy tissue can be performed in one operation.
- In addition, as a method of collecting tissue of a submucosal tumor, aspiration biopsy which is performed by Fine-Needle Aspiration (FNA), for example, is known. During the aspiration biopsy, tissue is punctured with a biopsy needle, and then the tissue is aspirated by filling a negative pressure in the biopsy needle with a syringe, and so on.
- According to a first aspect of the present invention, a medical treatment instrument includes: a tubular sheath; a needle formed in a tubular shape and inserted into the sheath such that the needle is capable of advancing and retracting; a stylet having a first outer diameter and inserted into the needle such that the stylet is capable of advancing and retracting; a housing portion which is elastically deformable at a distal end portion of the needle, the housing portion having a space formed in a tubular inside of the distal end portion of the needle; a small-diameter portion provided at a proximal end of the housing portion and having an inner diameter smaller than an inner diameter of the housing portion; a slit extending at least from a distal end of the housing portion to the small-diameter portion, the slit being configured to cause an outside of the needle to communicate with the space; and a large-diameter portion having a second outer diameter which is larger than the first outer diameter at a distal end portion of the stylet, the large-diameter portion being configured to, by the large-diameter portion being engaged with the small-diameter portion, cause the small-diameter portion and the housing portion to be elastically deformed to expand in a radial direction of the needle while a width of the slit expands.
- According to a second aspect of the present invention, in the medical treatment instrument according to the first aspect, the first outer diameter may be smaller than the inner diameter of the small-diameter portion. The second outer diameter may be larger than the inner diameter of the small-diameter portion and is smaller than the inner diameter of the housing portion.
- According to a third aspect of the present invention, in the medical treatment instrument according to the first aspect, the slit may include a plurality of slits which are formed at the housing portion.
- According to a fourth aspect of the present invention, in the medical treatment instrument according to the first aspect, the large-diameter portion may be positioned closer to a distal end side than the small-diameter portion in an initial state, and the large-diameter portion may expand the small-diameter portion by the stylet being pulled toward a proximal end side with respect to the needle.
- According to a fifth aspect of the present invention, in the medical treatment instrument according to the first aspect, when the large-diameter portion is disengaged from the small-diameter portion by the stylet being pulled toward proximal end side from a position at which the large-diameter portion is engaged with the small-diameter portion, the housing portion may be closed.
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FIG. 1 is a view showing an endoscope used together with a medical treatment instrument according to a first embodiment of the present invention. -
FIG. 2 is a lateral view of the medical treatment instrument. -
FIG. 3 is a lateral cross-sectional view of the medical treatment instrument. -
FIG. 4 is a view showing the medical treatment instrument viewed from an arrow A inFIG. 2 . -
FIG. 5 is a lateral cross-sectional view of a distal end portion of the medical treatment instrument. -
FIG. 6 is a lateral cross-sectional view when the distal end portion of the medical treatment instrument expands. -
FIG. 7 is a view showing an operation when the medical treatment instrument is being used. -
FIG. 8 is a view showing an operation when the medical treatment instrument is being used. -
FIG. 9 is a view showing an operation when the medical treatment instrument is being used. -
FIG. 10 is a view showing an operation when the medical treatment instrument is being used. -
FIG. 11 is a lateral cross-sectional view of a distal end portion of a medical treatment instrument according to a second embodiment of the present invention. -
FIG. 12 is a view showing a state in which a distal end portion of a needle of the medical treatment instrument is closed. -
FIG. 13 is a view showing a state in which the distal end portion of the needle of the medical treatment instrument is open. -
FIG. 14 is a view showing the needle viewed from an arrow B inFIG. 12 . -
FIG. 15 is a view showing an operation when the medical treatment instrument is being used. -
FIG. 16 is a view showing an operation when the medical treatment instrument is being used. -
FIG. 17 is a view showing an operation when the medical treatment instrument is being used. - Hereinafter, a first embodiment of the present invention will be described with reference to
FIGS. 1 to 10 .FIG. 1 is a view showing anendoscope 100 used together with amedical treatment instrument 1 according to the embodiment. - As shown in
FIG. 1 , theendoscope 100 includes anendoscope insertion part 101 inserted into a body, and anoperation part 102 which operates theendoscope insertion part 101. Theoperation part 102 is provided at a proximal end of theendoscope insertion part 101. Theoperation part 102 bends a distal end portion of theendoscope insertion part 101 by an angular wire (not shown). At a distal end of theendoscope insertion part 101, a known imaging means which observes an inside of the body is provided. Achannel 103 is formed inside theendoscope insertion part 101. Thechannel 103 extends from the distal end of theendoscope insertion part 101 to a portion near a side part of theoperation part 102. An opening of a distal end of thechannel 103 is formed at the distal end of theendoscope insertion part 101, and an opening of a proximal end of thechannel 103 is formed at the portion near the side part of theoperation part 102. The opening of the proximal end of thechannel 103 is an insertion port of a treatment instrument which is inserted into theendoscope 100. Themedical treatment instrument 1 according to the embodiment is inserted into thechannel 103 through the insertion port. -
FIG. 2 is a lateral view of themedical treatment instrument 1 according to the embodiment.FIG. 3 is a lateral cross-sectional view of themedical treatment instrument 1.FIG. 4 is a view showing themedical treatment instrument 1 viewed from an arrow A inFIG. 2 .FIG. 5 is a lateral cross-sectional view of a distal end portion of themedical treatment instrument 1. As shown inFIG. 2 , themedical treatment instrument 1 includes aneedle 10, astylet 30, and asheath 40. Theneedle 10 is formed in a tubular shape and is inserted into thesheath 40 to be capable of advancing and retracting. Thestylet 30 has a predetermined outer diameter (first outer diameter) and is inserted into theneedle 10 to be capable of advancing and retracting. - The
needle 10 is constituted with a metal such as stainless steel or a nickel-titanium alloy and can be elastically deformed. Theneedle 10 is formed in the tubular shape and has alumen 11. Like a general puncturing needle, theneedle 10 may be, for example, a 19-gauge needle (outer diameter of 1.1 mm, inner diameter of 0.78 mm). In addition, a needle which is narrower than the needle having the size above may also be used as theneedle 10. A distal end of theneedle 10 is formed in the shape of a curved surface so as to easily puncture tissue with theneedle 10. In addition, the distal end of theneedle 10 may also be formed in an acute shape. - A
distal end portion 12 of theneedle 10 can be elastically deformed. As shown inFIG. 5 , thedistal end portion 12 of theneedle 10 has ahousing portion 14, a small-diameter portion 16, and aslit 18. Aspace 15 is formed in thehousing portion 14. The small-diameter portion 16 is provided at a proximal end of thehousing portion 14, and has a smaller inner diameter than an inner diameter of thehousing portion 14. Theslit 18 extends at least from a distal end of thehousing portion 14 to a proximal end of the small-diameter portion 16, and communicates with thespace 15. - The
space 15 capable of accommodating tissue to be collected is formed in thehousing portion 14. The inner diameter and the outer diameter of thehousing portion 14 are substantially the same as the inner diameter and the outer diameter of theneedle 10 which is closer to the proximal end side than thedistal end portion 12, respectively. However, the inner diameter and the outer diameter of thehousing portion 14 may respectively be set differently from the inner diameter and the outer diameter of theneedle 10 which is closer to the proximal end side than thedistal end portion 12. The length of thehousing portion 14 in an axial direction of theneedle 10 is properly set depending on an amount of tissue to be collected. The size of thespace 15 is defined by the inner diameter of thehousing portion 14 and the length of thehousing portion 14 in the axial direction of theneedle 10. - The small-
diameter portion 16 is provided at the proximal end of thehousing portion 14. The small-diameter portion 16 has a smaller inner diameter than other portions of theneedle 10 including thehousing portion 14. The small-diameter portion 16 may be formed by making a part of a proximal end side of thehousing portion 14 in theneedle 10 concave in a radial direction of theneedle 10. In this case, the small-diameter portion 16 has a smaller outer diameter than other portions of theneedle 10 including thehousing portion 14. A proximal end of the small-diameter portion 16 continues to a straight tube portion of theneedle 10. The straight tube portion of theneedle 10 is formed in the shape of a tube with a fixed inner diameter and a fixed outer diameter. - The
slit 18 is formed at thedistal end portion 12, and extends from the distal end of the needle 10 (distal end of the housing portion 14) to the proximal end of thedistal end portion 12. Theslit 18 should extend at least from the distal end of theneedle 10 to the proximal end of the small-diameter portion 16. In the embodiment, an example in which threeslits 18 are formed is shown. However, the number of slits is not limited as long as there are one or more slits. When a plurality ofslits 18 are formed, as in the embodiment shown inFIG. 4 , theslits 18 are preferably formed at equal intervals in a circumferential direction of theneedle 10. Theslits 18 communicate with thelumen 11 and thespace 15. In addition, theslits 18 intersect with or join each other at the distal end of theneedle 10. Thus, thedistal end portion 12 is divided into three portions by theslits 18. The widths of theslits 18 in the circumferential direction of theneedle 10 are not particularly limited as long as thedistal end portion 12 is divided by theslits 18. In order to prevent foreign substances other than target tissue from being mixed in thespace 15, the widths of theslits 18 are preferably as narrow as possible. In addition, in the embodiment, although theslits 18 are formed in linear shapes along a longitudinal axis of theneedle 10, the shapes of theslits 18 are not limited thereto. For example, theslits 18 may be formed in linear shapes inclined with respect to the longitudinal axis of theneedle 10 or curved shapes. - As shown in
FIGS. 2 and 3 , aneedle operation part 20 is provided at the proximal end of theneedle 10. Inside theneedle operation part 20, aninsertion passage 21 which communicates with thelumen 11 is formed. By advancing and retracting theneedle operation part 20, theneedle 10 can advance and retract with respect to thesheath 40. - The
stylet 30 has the predetermined outer diameter (first outer diameter), and is inserted into theneedle 10 to be capable of advancing and retracting. Thestylet 30 is constituted with metal such as stainless steel, and is formed in the shape of a round rod. Thestylet 30 is inserted into thelumen 11 and theinsertion passage 21, and is capable of advancing and retracting with respect to theneedle 10. The outer diameter (first outer diameter) of thestylet 30 is smaller than the inner diameter of the small-diameter portion 16. - A
distal end portion 32 of thestylet 30 has a large-diameter portion 34. The large-diameter portion 34 is formed in a substantially cylindrical shape, and has an outer diameter (second outer diameter) larger than the outer diameter (first outer diameter) of other portions of thestylet 30. The outer diameter (second outer diameter) of the large-diameter portion 34 is larger than the inner diameter of the small-diameter portion 16, and is smaller than the inner diameter of thehousing portion 14. - A
stylet operation part 36 is provided at a proximal end of thestylet 30. By advancing and retracting thestylet operation part 36, thestylet 30 can advance and retract with respect to theneedle 10. - The
sheath 40 is constituted with a resin material, and is formed in a tubular shape. In addition, thesheath 40 may be formed by a coil sheath around which a wire of a metal material such as stainless steel is tightly wound with no gaps formed therebetween. Theneedle 10 is inserted into a lumen of thesheath 40 to be capable of advancing and retracting with respect to thesheath 40. When themedical treatment instrument 1 is inserted into thechannel 103, the distal end of theneedle 10 is stored in thesheath 40. In this way, damage of theneedle 10 or thechannel 103 due to direct contact between theneedle 10 and an inner surface of thechannel 103 is prevented. - A
sheath operation part 42 is provided at a proximal end of thesheath 40. By advancing and retracting thesheath operation part 42, thesheath 40 can advance and retract with respect to thechannel 103 of theendoscope 100. - Next, an operation of the
distal end portion 12 will be described.FIG. 6 is a lateral cross-sectional view when the distal end portion of themedical treatment instrument 1 expands. As shown inFIG. 6 , the large-diameter portion 34 can be engaged with the small-diameter portion 16. In a normal state, the inner diameter of the small-diameter portion 16 is smaller than the outer diameter of the large-diameter portion 34. However, since theneedle 10 can be elastically deformed, by the width of theslit 18 being expanded in the circumferential direction of theneedle 10, the inner diameter of the small-diameter portion 16 can be expanded up to the size which is approximately the same as the outer diameter of the large-diameter portion 34. For this reason, the large-diameter portion 34 can be engaged with the small-diameter portion 16. - In the embodiment, as shown in
FIG. 5 , the large-diameter portion 34 is positioned closer to the distal end side than the small-diameter portion 16 in an initial state. From this state, by retracting thestylet operation part 36 to pull thestylet 30 toward the proximal end side with respect to theneedle 10, as shown inFIG. 6 , the large-diameter portion 34 moves toward the proximal end side and is engaged with the small-diameter portion 16 so that the width of each of theslits 18 expands. When the large-diameter portion 34 is engaged with the small-diameter portion 16, an operator who operates thestylet operation part 36 feels an operation sensation (clicking sensation). Since thedistal end portion 12 is divided into three portions by theslits 18 as described above, by expanding the widths of theslits 18, each of the three portions of thedistal end portion 12 is elastically deformed to move toward the outside in the radial direction of theneedle 10. That is, thehousing portion 14 and the small-diameter portion 16 expand in the radial direction of theneedle 10 so that thespace 15 is open to the outside of theneedle 10. - By moving the large-
diameter portion 34 engaged with the small-diameter portion 16 further toward the proximal end by operating thestylet operation part 36, the engagement between the large-diameter portion 34 and the small-diameter portion 16 is released, and the large-diameter portion 34 moves toward the proximal end side of the small-diameter portion 16. As the engagement between the large-diameter portion 34 and the small-diameter portion 16 is released, each of the three portions of thedistal end portion 12 is elastically deformed to move to the inside in the radial direction of theneedle 10 by an elastic force attempting to restore to the original shape of theneedle 10, and the width of each of theslits 18 is restored to the original size. That is, thehousing portion 14 and the small-diameter portion 16 are closed, and thespace 15 is closed with respect to the outside of theneedle 10. In addition, in the above example, although the operation of thedistal end portion 12 when the large-diameter portion 34 is moved from the distal end side toward the proximal end side of the small-diameter portion 16 has been described, thedistal end portion 12 performs the same operation when the large-diameter portion 34 is moved from the proximal end side toward the distal end side of the small-diameter portion 16. - Next, treatment using the
medical treatment instrument 1 according to the embodiment will be described with reference toFIGS. 7 to 10 .FIGS. 7 to 10 are views showing an operation when themedical treatment instrument 1 is being used. Here, the above treatment of collecting tissue of a gastric submucosal tumor will be described as an example. As shown inFIG. 7 , on a stomach wall, a mucosa M, muscularis mucosae MM, a submucosa SM, a proper muscle PM, and a subserosa SS are disposed in that order, and a submucosal tumor ST is formed in the proper muscle PM. - First, an operator inserts the
endoscope insertion part 101 of theendoscope 100 from a patient's mouth into the body cavity, and moves the distal end of theendoscope insertion part 101 up to a portion near a target portion T. Themedical treatment instrument 1 is inserted into thechannel 103, and the distal end of themedical treatment instrument 1 is moved up to the distal end of theendoscope insertion part 101. Here, the distal end of theneedle 10 is stored in thesheath 40. In addition, in the treatment example, a case in which the large-diameter portion 34 of thestylet 30 is arranged at the distal end side of the small-diameter portion 16 of theneedle 10 in the initial state will be described. - The operator operates the
sheath operation part 42 to cause thesheath 40 to protrude from the distal end of theendoscope insertion part 101 while observing the target portion T with an imaging means provided at the distal end of theendoscope insertion part 101. Then, the operator advances theneedle operation part 20 to cause theneedle 10 to protrude from the distal end of thesheath 40, and punctures the target portion T by theneedle 10. - When the target portion T is punctured by the
needle 10, as shown inFIG. 7 , the operator first inserts the distal end of theneedle 10 into the submucosa SM. Next, as shown inFIG. 8 , the operator retracts thestylet operation part 36 and pulls thestylet 30 toward the proximal end side with respect to theneedle 10 to move the large-diameter portion 34 toward the proximal end side. Thus, the large-diameter portion 34 is engaged with the small-diameter portion 16, and thehousing portion 14 expands. Here, since thehousing portion 14 is inside the mucosa M, the operator is unable to see that thehousing portion 14 has expanded with the imaging means of theendoscope insertion part 101. However, the operator can determine that thehousing portion 14 has expanded by feeling the clicking sensation generated due to the engagement between the large-diameter portion 34 and the small-diameter portion 16. - Then, in this state, the operator operates the
needle operation part 20 and sticks theneedle 10 into the submucosal tumor ST as shown inFIG. 9 . The operator retracts thestylet operation part 36 and pulls thestylet 30 further toward the proximal end side with respect to theneedle 10 to move the large-diameter portion 34 further toward the proximal end side. Thus, the engagement between the large-diameter portion 34 and the small-diameter portion 16 is released, and as shown inFIG. 10 , thehousing portion 14 is closed by the elastic force of theneedle 10. When thehousing portion 14 is closed, tissue of the submucosal tumor ST can be collected into thespace 15. Here, depending on the amount of tissue being collected, there are cases in which thehousing portion 14 is inflated slightly more than in the originally closed state. That is, thehousing portion 14 can collect tissue of a larger volume than a volume defined by the inner diameter of the housing portion in a state in which thehousing portion 14 is closed. While thehousing portion 14 is closed, the operator retracts theneedle operation part 20 to retract theneedle 10 until the distal end of theneedle 10 is stored in thesheath 40. The operator withdraws themedical treatment instrument 1 from thechannel 103. - In addition, although it has been described above that the large-
diameter portion 34 is arranged at the distal end side of the small-diameter portion 16 in the initial state, the large-diameter portion 34 may be arranged at the proximal end side of the small-diameter portion 16 in the initial state. In this case, the operation of moving the large-diameter portion 34 toward the proximal end side in the description above is substituted with an operation of moving the large-diameter portion 34 toward the distal end side. - In the
medical treatment instrument 1 according to the embodiment, theslits 18 are provided at thedistal end portion 12 of theneedle 10, and the distal end portion 12 (thehousing portion 14 and the small-diameter portion 16) can be elastically deformed to expand toward the outside in the radial direction. In this way, a sufficient amount of tissue can be collected even when the outer diameter of theneedle 10 is narrow. In addition, in themedical treatment instrument 1 according to the embodiment, from the state in which thedistal end portion 12 has expanded toward the outside in the radial direction, thedistal end portion 12 is restored to the originally closed state by its elastic force. For this reason, even when collecting tissue of the submucosal tumor which is hard tissue, thedistal end portion 12 can be restored to the originally closed state by its elastic force overcoming the hardness of the tissue, and the tissue can be reliably collected. - In addition, in the
medical treatment instrument 1 according to the embodiment, a blade may be formed at a portion where theslit 18 of thedistal end portion 12 of theneedle 10 is formed. In this way, when thedistal end portion 12 is closed, the tissue can be easily split and collected. - In the
medical treatment instrument 1 according to the embodiment, the operator can recognize that the large-diameter portion 34 is engaged with the small-diameter portion 16 by the clicking sensation. In addition, by providing a known stopper mechanism, which stops thestylet 30 at a time when thestylet 30 has been operated by a predetermined amount, at thestylet operation part 36, themedical treatment instrument 1 may be constituted in a way that the operator can check that the large-diameter portion 34 is engaged with the small-diameter portion 16. - In the
medical treatment instrument 1 according to the embodiment, thesheath 40 is not an essential constitution. Themedical treatment instrument 1 may not include thesheath 40. In addition, instead of thesheath 40, a known sheath and themedical treatment instrument 1 may be used in combination. - Next, a second embodiment of the present invention will be described with reference to
FIGS. 11 to 17 . Amedical treatment instrument 201 according to the embodiment is different from themedical treatment instrument 1 according to the first embodiment in that thestylet 30 is not included. Further, in themedical treatment instrument 201 according to the embodiment, constitutions of the distal end portion of theneedle 10 and the distal end portion of thesheath 40 are different from those of themedical treatment instrument 1 according to the first embodiment. In addition, with respect to parts having the same constitutions as themedical treatment instrument 1 according to the first embodiment, a detailed description thereof will be omitted. -
FIG. 11 is a lateral cross-sectional view of a distal end portion of themedical treatment instrument 201 according to the embodiment.FIG. 12 is a view showing a state in which adistal end portion 212 of aneedle 210 of themedical treatment instrument 201 is closed.FIG. 13 is a view showing a state in which thedistal end portion 212 of theneedle 210 of themedical treatment instrument 201 is open.FIG. 14 is a view showing theneedle 210 viewed from an arrow B inFIG. 12 . As shown inFIG. 11 , themedical treatment instrument 201 includes theneedle 210 and asheath 240, but does not include a stylet. - As shown in
FIGS. 11 and 12 , thedistal end portion 212 of theneedle 210 includes ahousing portion 214, astraight tube portion 222 provided at a proximal end of thehousing portion 214, and a steppedportion 224 provided at a proximal end of thestraight tube portion 222. As in the first embodiment, aspace 215 capable of accommodating tissue to be collected is formed in thehousing portion 214. In addition, aslit 218 which extends from the distal end to the proximal end of thehousing portion 214 is formed in thehousing portion 214. In the embodiment, although an example in which threeslits 218 are formed is shown, the number of slits is not limited thereto as long as there are one or more slits. When the plurality of slits are formed, as in the embodiment shown inFIG. 14 , theslits 218 are preferably formed at equal intervals in a circumferential direction of theneedle 210. Each of theslits 218 communicates with thespace 215. In addition, theslits 218 intersect with or join each other at the distal end of theneedle 210. Thus, thehousing portion 214 is divided into three portions by theslits 218. As shown inFIG. 13 , each of the three portions of thehousing portion 214 is formed in a shape that expands toward the outside in the radial direction of theneedle 210 by plastic deformation. In addition, since theneedle 210 can be elastically deformed like theneedle 10 of the first embodiment, as shown inFIG. 11 , thehousing portion 214 can be elastically deformed in the closed state by a sheathdistal end member 242 to be described below. As shown inFIG. 12 , while thehousing portion 214 is closed, the distal end of thehousing portion 14 is formed in the shape of a curved surface. Thus, in this state, tissue can be easily punctured by theneedle 210. An outer diameter of thehousing portion 214 when thehousing portion 214 is closed is properly set in consideration of the puncturing performance. - The
straight tube portion 222 is disposed between thehousing portion 214 and the steppedportion 224. Thestraight tube portion 222 has an inner diameter and an outer diameter which are respectively substantially the same as the inner diameter and the outer diameter of thehousing portion 214 when thehousing portion 214 is closed. The outer diameter of thestraight tube portion 222 is smaller than an outer diameter of portions of theneedle 210 other than thehousing portion 214. The length of thestraight tube portion 222 in the axial direction of theneedle 210 is properly set depending on a length to which target tissue is punctured by theneedle 210. - The stepped
portion 224 has a shape which extends from thestraight tube portion 222 while an outer diameter thereof expanding. The steppedportion 224 comes in contact with a protrudingportion 244 of the sheathdistal end member 242 to be described below. By the steppedportion 224 coming in contact with the protrudingportion 244, theneedle 210 is prevented from moving further toward the distal end side with respect to thesheath 240. - The sheath
distal end member 242 is mounted at a distal end of thesheath 240. The sheathdistal end member 242 is formed in a tubular shape having an inner diameter and an outer diameter which are respectively substantially the same as the inner diameter and the outer diameter of thesheath 240. A lumen of the sheathdistal end member 242 communicates with a lumen of thesheath 240, and theneedle 210 is inserted into the lumen of the sheathdistal end member 242. Theneedle 210 can advance and retract with respect to thesheath 240 and the sheathdistal end member 242. The protrudingportion 244 which protrudes toward the inside in the radial direction of the sheathdistal end member 242 is provided at the distal end of the sheathdistal end member 242. At the distal end of the sheathdistal end member 242, anopening 246 which communicates with the lumen of the sheathdistal end member 242 is formed further toward the inside in the radial direction than the protrudingportion 244. The diameter of theopening 246 is slightly larger than the outer diameter of thestraight tube portion 222, and is smaller than the outer diameter of the steppedportion 224. Thus, although thestraight tube portion 222 can be inserted into theopening 246, the steppedportion 224 cannot be inserted into theopening 246 due to coming in contact with the protrudingportion 244. By being elastically deformed in the closed state, thehousing portion 214 can be inserted into theopening 246. That is, by thehousing portion 214 being inserted into theopening 246, an outer surface of thehousing portion 214 is pressed by the protrudingportion 244, and thehousing portion 214 is elastically deformed in the closed state. - Next, treatment using the
medical treatment instrument 201 according to the embodiment will be described usingFIGS. 15 to 17 .FIGS. 15 to 17 are views for describing an operation when themedical treatment instrument 201 is being used. As in the first embodiment, the treatment of collecting tissue of a gastric submucosal tumor will be described as an example. - First, as in the first embodiment, the operator uses the
endoscope 100 to send the distal end of themedical treatment instrument 201 to a portion near the target portion T. The operator advances theneedle operation part 20 to cause theneedle 210 to protrude from the distal end of the sheathdistal end member 242. Here, as shown inFIG. 15 , a part of thehousing portion 214 is arranged in theopening 246, and thehousing portion 214 is closed by the protrudingportion 244. In this state, the operator punctures the target portion T with theneedle 210. - Next, the operator advances the
needle 210 with respect to the sheathdistal end member 242. In this way, when thehousing portion 214 passes the protrudingportion 244 and moves toward the distal end side, as shown inFIG. 16 , thehousing portion 214 is restored to the originally expanded state while pushing circumferential tissue by an elastic force attempting to restore to the original shape of thehousing portion 214. In this state, as shown inFIG. 17 , the operator further advances theneedle 210 with respect to the sheathdistal end member 242 until the steppedportion 224 comes in contact with the protrudingportion 244. In this way, tissue of the submucosal tumor ST is accommodated in thespace 215 of thehousing portion 214. When the operator retracts theneedle 210 with respect to the sheathdistal end member 242, the outer surface of thehousing portion 214 is pressed by the protrudingportion 244, and thus thehousing portion 214 is closed by elastic deformation. In this way, the tissue accommodated in thespace 215 can be collected. Then, theneedle 210 is withdrawn from the target portion T, and themedical treatment instrument 201 is withdrawn from the body. - In the
medical treatment instrument 201 according to the embodiment, theslits 218 are provided at thehousing portion 214 of theneedle 210, thehousing portion 214 is formed by plastic deformation in the shape that expands toward the outside in the radial direction, and thehousing portion 214 can be closed by elastic deformation. Accordingly, after tissue is punctured by theneedle 210 while thehousing portion 214 is closed, thehousing portion 214 is expanded, and thus a sufficient amount of tissue can be collected even when the outer diameter of theneedle 210 is narrow. In addition, in themedical treatment instrument 201 according to the embodiment, thehousing portion 214 is closed due to the outer surface of thehousing portion 214 being pressed by the protrudingportion 244 of the sheathdistal end member 242. Accordingly, even when collecting tissue of a submucosal tumor which is hard tissue, thehousing portion 214 can be closed with a force overcoming the hardness of the tissue, and the tissue can be reliably collected. - Although preferred embodiments of the present invention have been described above, the present invention is not limited to the embodiments. Additions, omissions, substitutions, and other modifications can be made without departing from the spirit and scope of the present invention. The present invention is not limited by the description above, and is only limited by the scope of the appended claims.
Claims (5)
1. A medical treatment instrument comprising:
a tubular sheath;
a needle formed in a tubular shape and inserted into the sheath such that the needle is capable of advancing and retracting;
a stylet having a first outer diameter and inserted into the needle such that the stylet is capable of advancing and retracting;
a housing portion which is elastically deformable at a distal end portion of the needle, the housing portion having a space formed in a tubular inside of the distal end portion of the needle;
a small-diameter portion provided at a proximal end of the housing portion and having an inner diameter smaller than an inner diameter of the housing portion;
a slit extending at least from a distal end of the housing portion to the small-diameter portion, the slit being configured to cause an outside of the needle to communicate with the space; and
a large-diameter portion having a second outer diameter which is larger than the first outer diameter at a distal end portion of the stylet, the large-diameter portion being configured to, by the large-diameter portion being engaged with the small-diameter portion, cause the small-diameter portion and the housing portion to be elastically deformed to expand in a radial direction of the needle while a width of the slit expands.
2. The medical treatment instrument according to claim 1 , wherein
the first outer diameter is smaller than the inner diameter of the small-diameter portion, and
the second outer diameter is larger than the inner diameter of the small-diameter portion and is smaller than the inner diameter of the housing portion.
3. The medical treatment instrument according to claim 1 , wherein the slit comprises a plurality of slits which are formed at the housing portion.
4. The medical treatment instrument according to claim 1 , wherein the large-diameter portion is positioned closer to a distal end side than the small-diameter portion in an initial state, and the large-diameter portion expands the small-diameter portion by the stylet being pulled toward a proximal end side with respect to the needle.
5. The medical treatment instrument according to claim 1 , wherein, when the large-diameter portion is disengaged from the small-diameter portion by the stylet being pulled toward proximal end side from a position at which the large-diameter portion is engaged with the small-diameter portion, the housing portion is closed.
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2014-166318 | 2014-08-19 | ||
JP2014166318 | 2014-08-19 | ||
PCT/JP2015/063098 WO2016027523A1 (en) | 2014-08-19 | 2015-05-01 | Medical treatment instrument |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/JP2015/063098 Continuation WO2016027523A1 (en) | 2014-08-19 | 2015-05-01 | Medical treatment instrument |
Publications (1)
Publication Number | Publication Date |
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US20160324536A1 true US20160324536A1 (en) | 2016-11-10 |
Family
ID=55350477
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US15/215,035 Abandoned US20160324536A1 (en) | 2014-08-19 | 2016-07-20 | Medical treatment instrument |
Country Status (5)
Country | Link |
---|---|
US (1) | US20160324536A1 (en) |
EP (1) | EP3184055A4 (en) |
JP (1) | JP5927365B1 (en) |
CN (1) | CN105979881B (en) |
WO (1) | WO2016027523A1 (en) |
Families Citing this family (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10631836B2 (en) | 2016-04-07 | 2020-04-28 | Gyrus Acmi, Inc. | Laparoscopic surgical device with flared tube |
WO2022244711A1 (en) * | 2021-05-18 | 2022-11-24 | オリンパス株式会社 | Biopsy device and specimen sampling device |
Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US765879A (en) * | 1904-05-13 | 1904-07-26 | Wilber A K Campbell | Dilator. |
US6217549B1 (en) * | 1997-02-28 | 2001-04-17 | Lumend, Inc. | Methods and apparatus for treating vascular occlusions |
US6652549B1 (en) * | 1999-01-19 | 2003-11-25 | Le Maitre Vascular, Inc. | Device for stripping veins |
US20060271096A1 (en) * | 2002-10-25 | 2006-11-30 | Hamada James S | Minimal incision maximal access MIS spine instrumentation and method |
Family Cites Families (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6508825B1 (en) * | 1997-02-28 | 2003-01-21 | Lumend, Inc. | Apparatus for treating vascular occlusions |
AU6604898A (en) * | 1997-03-13 | 1998-09-29 | Biomax Technologies, Inc. | Catheters and endoscopes comprising optical probes and bioptomes and methods of using the same |
JP4758173B2 (en) * | 2004-12-24 | 2011-08-24 | オリンパス株式会社 | Ligation device |
CN101087564B (en) * | 2004-12-24 | 2010-06-02 | 奥林巴斯株式会社 | Ligation device |
JP2006334242A (en) * | 2005-06-03 | 2006-12-14 | Olympus Medical Systems Corp | Medical treatment device |
JP4777012B2 (en) * | 2005-08-11 | 2011-09-21 | オリンパスメディカルシステムズ株式会社 | Medical treatment tool |
WO2009111717A1 (en) * | 2008-03-06 | 2009-09-11 | Trustees Of Boston University | Low cost disposable medical forceps to enable a hollow central channel for various functionalities |
JP5647775B2 (en) * | 2009-07-27 | 2015-01-07 | Hoya株式会社 | Endoscopic biopsy forceps |
CN103687640B (en) * | 2012-07-18 | 2016-03-02 | 泰尔茂株式会社 | Medical treatment instrument |
-
2015
- 2015-05-01 EP EP15833353.4A patent/EP3184055A4/en not_active Withdrawn
- 2015-05-01 JP JP2016501907A patent/JP5927365B1/en active Active
- 2015-05-01 WO PCT/JP2015/063098 patent/WO2016027523A1/en active Application Filing
- 2015-05-01 CN CN201580005661.6A patent/CN105979881B/en active Active
-
2016
- 2016-07-20 US US15/215,035 patent/US20160324536A1/en not_active Abandoned
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US765879A (en) * | 1904-05-13 | 1904-07-26 | Wilber A K Campbell | Dilator. |
US6217549B1 (en) * | 1997-02-28 | 2001-04-17 | Lumend, Inc. | Methods and apparatus for treating vascular occlusions |
US6652549B1 (en) * | 1999-01-19 | 2003-11-25 | Le Maitre Vascular, Inc. | Device for stripping veins |
US20060271096A1 (en) * | 2002-10-25 | 2006-11-30 | Hamada James S | Minimal incision maximal access MIS spine instrumentation and method |
Also Published As
Publication number | Publication date |
---|---|
EP3184055A4 (en) | 2018-04-04 |
WO2016027523A1 (en) | 2016-02-25 |
CN105979881A (en) | 2016-09-28 |
EP3184055A1 (en) | 2017-06-28 |
JPWO2016027523A1 (en) | 2017-04-27 |
CN105979881B (en) | 2019-08-23 |
JP5927365B1 (en) | 2016-06-01 |
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Legal Events
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AS | Assignment |
Owner name: OLYMPUS CORPORATION, JAPAN Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:TAKAHASHI, ICHIRO;REEL/FRAME:039200/0781 Effective date: 20160630 |
|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |